(UNDATED) - More than 600,000 American middle school students and 3 million high school students - including 18 percent of Hoosier high schoolers - smoke cigarettes, according to a new report by the United States surgeon general.

Dann Denny of the Hearld-Times reports that one of every four U.S. high school seniors is a regular cigarette smoker, and 80 percent of them will carry their addiction into adulthood, the report says.

"Many young people don't start smoking with the intention of continuing to do so as adults, but nicotine is highly addictive, and it's really hard to quit once they become established smokers," said Jon Macy, assistant professor in the Department of Applied Health Science in the School of HPER at Indiana University and coordinator for the Monroe Tobacco Prevention and Cessation Coalition.

Smoking is the leading cause of preventable death in the United States, killing more than 1,200 people every day and more than 9,700 Hoosiers a year. And for every tobacco-related death in the U.S., two new "replacement" smokers under the age of 25 take up the habit.

But in an era in which it's widely known that tobacco use increases the long-term likelihood of dying from lung cancer, heart disease or stroke, why are so many young people willing to light up?

"A lot of researchers feel the most powerful predictor of teens smoking is how many smoking images they are exposed to in movies," Macy said. "When a teen sees smoking in a movie, it's usually portrayed as being cool and fun and attractive. It's almost never portrayed in a negative way."

The report found that in 2010, nearly a third of top-grossing movies for children - those with G, PG, or PG-13 ratings - contained images of tobacco use, often portrayed as a normal, even appealing, activity.

Macy said he was encouraged by the Motion Picture Association of America's decision to take into account smoking by adults, particularly those that glamorize smoking or show pervasive smoking outside a historical context, in assigning its film ratings. The decision adds smoking to a list of such factors as sex, violence and foul language in determining the association's G, PG, PG-13, R and NC-17 ratings.

He said many are pressuring the association to go further by assigning any movie that shows smoking an R rating, which would restrict those younger than 17 from seeing it unless accompanied by an adult.

In the meantime, he said parents can check out the website - www.scene smoking.org - which each week gives certain movies ratings based on how they depict tobacco.
Flavored tobacco

The report criticized tobacco companies for targeting youth, saying tobacco companies are spending more than $10 billion a year marketing their products, almost double the amount they spent in 1998. More than $307 million each year is spent on marketing tobacco products in Indiana.

Macy said tobacco companies for years have targeted young people. An estimated 3,800 kids pick up their first cigarette every day, and 9 in 10 current smokers start before the age of 18, the report says, adding that 99 percent of all first-time tobacco use happens by age 26.

"The tobacco companies are highly skilled at what they do - developing messaging that helps them accomplish their goal of selling cigarettes to youth to make money," he said.

Macy said the tobacco company's latest marketing strategy features flavored tobacco products, such as grape-flavored cigars and mint-flavored dip.

"They're always trying something new," he said. "The FDA's new regulations say tobacco companies can't make flavored cigarettes but they can make flavored cigars.
They are allowed to make mentholated cigarettes, which are really popular among youth in African-American communities. But a lot of people feel the FDA should ban all flavored tobacco products, because they are clearly targeting kids."

The report found that in recent years, tobacco advertising has promoted the myth that smoking makes and keeps you thin, a message that is especially appealing to many young girls. But smoking teens are no thinner than non-smoking teens, the report says.

But the message is working," Macy said. "It's now pretty much an accepted belief by many people that if you quit smoking, you will gain weight."

Indiana doing well

Although U.S. smoking rates have fallen since 1964, when the surgeon general issued the first health warnings on smoking, progress in curbing youth smoking has stalled in the past decade.

But in Indiana, high school smoking rates have declined from 32 percent in 2000 to 18 percent in 2011, resulting in 258,000 fewer teen smokers.

"My guess is that's because Indiana has continued to invest in tobacco prevention programs," Macy said. "But in recent years, the state Legislature has chiseled away at the budget for tobacco prevention and cessation. If that trend continues, I'm afraid the rate of teen smoking will level off, or even increase."

What's helping?

The report says there is an urgent need to employ proven methods nationwide that help prevent young people from smoking, such as passing smoke-free air laws, increasing tobacco excise taxes and offering tobacco prevention programs.

"Young people are more price-sensitive than adults, because they typically have less disposable income to spend on cigarettes," Macy said. "That's why tobacco companies are trying to counteract the tax increases by offering price promotions - things like coupons and 2-for-1 deals."

Macy said research shows that kids who live in towns with smoke-free laws are less likely to experiment or become established smokers than kids who live in towns that don't, and that tobacco-prevention programs - particularly those that inform kids that they are being targeted by the tobacco companies and urging them to fight back - have been shown to be effective.

A 2011 Indiana University study comparing the smoking behavior among students at IU, which went smoke-free Jan. 1, 2008, with those of students at Purdue University, which does not have a campuswide smoke-free air policy, found that during a 2.5-year period between the fall of 2007 and December of 2009, the percentage of students smoking at IU dropped 3.7 percentage points to 12.8 percent, while the smoking rate increased slightly at Purdue University, to 10.1 percent.